Hundreds of churchgoers in in North Dakota may have been exposed to the hepatitis A virus in September and October at communion services attended by a bishop known to be carrying the disease.

The virus, while rarely fatal, can be easily transmitted through exposure to an infected person. The state’s health department found that people who had attended and taken communion at four separate church services in Fargo and Jamestown may have been exposed, and issued an advisory warning, the Associated Press reports. The bishop, John Folda, gave communion at the churches, and reportedly contracted the virus from contaminated food while at a conference for recently ordained bishops in Italy.

Folda has taken time off since Oct. 10 due to the virus, a Fargo Catholic Diocese spokeswoman told the AP.

Hepatitis A, if left untreated, can cause liver ailment and symptoms include fever, tiredness, loss of appetite and nausea among others. However, risk of exposure is still relatively low in churches that practice communion. “Common cups” are used, but clergy use precautions and are typically trained in methods that would minimize any exposure to viral infection.

“The risk of people getting hepatitis A in this situation is low, but the Department of Health felt it was important for people to know about the possible exposure,” Molly Howell, a North Dakota Health Department official, said in a statement. “Only people who attended these specific churches and had communion on these dates were possibly exposed to hepatitis A and should be tested if symptomatic.”